Promoting Health and Wellbeing of Children and Families Through Relationship Based Interventions

Welcome to my blog, which speaks to parents, professionals who work with children, and policy makers. I aim to show how contemporary developmental science points us on a path to effective prevention, intervention, and treatment, with the aim of promoting healthy development and wellbeing of all children and families.

Thursday, December 17, 2015

As both a pediatrician and psychoanalyst, D.W. Winnicott had a unique view of human development. In his pediatric practice, he was immersed in the lives of developing infants and parents. (As the mother was usually the primary caregiver at the time he was practicing, he writes primarily of the mother-baby relationship.) In his psychoanalytic practice where his patients, in his words "regressed to dependence," he had a kind of mothering experience with an adult person who could communicate with both body and verbal language.

In preparation for teaching a course on early childhood mental health at William James College starting in January, I have had the pleasure of reconnecting with the profound wisdom of his writings. While Winnicott wrote extensively for both a general and a professional audience, I discovered, on careful re-reading of his essay for a general audience entitled "The Ordinary Devoted Mother" that it contains a vast wealth of ideas. In fact, if I had to assign only one paper for the entire course, this could be it.

He begins in his delightfully humble way by saying that he had no wish to tell mothers what to do because, " To start with, I didn't know." Like his American counterpart Benjamin Spock, he acknowledges the mother as the expert with respect to her child.

Identifying how his approach is sometimes misinterpreted as blaming mothers, he calls attention to an inherent conflict. He writes:

"But is it not natural that if this thing called devotion is
really important, then its absence or relative failure in this area should have
consequences that are untoward?"

Later in the essay he returns to the problem of blame, but first points out that this ordinary devotion is contingent on the mother herself being cared for.

“I think that by the time the
baby is ripe for birth the mother, if properly cared for herself by her man or
the welfare state or both, is ready for an experience in which she knows
extremely well what are the baby's needs."

Had he been writing today he would likely call attention the profound implication of our failure to support for mothers in the postpartum period, as represented by the absence of government sponsored paid parental leave. We are uniquely lacking in a culture of postpartum care, as I describe in detail in a previous post.

Next Winnicott introduces another central concept of his, referred to in other works as "the holding environment." He identifies the profound nature of the care a mother offers:

"You will understand I am not simply referring to her being able to know whether the baby is hungry or not, and all that sort of thing; I am referring to innumerable subtle things, things that only my friend the poet could put into words. For my part, I am contented with the word hold, and to extend its meaning to cover all that a mother is and does at this time."

He then goes on to speak of what in his other writings he refers to as the "good-enough mother." He describes how a mother in a healthy way fails to adapt completely to her baby's needs, in parallel with his growing ability to manage frustration.

"In time the baby begins to
need the mother to fail to adapt-this failure being also a graduated process
that cannot be learned from books. It would be irksome for a human child to go
on experiencing omnipotence when the apparatus has arrived which can cope with
frustration and relative environmental failures. There is much satisfaction to
be got from anger that does not go over into despair."

This concept has been supported in the research of developmental psychologist Ed Tronick who has shown that these very disruptions, along with their subsequent repair, give a developing child a positive sense of himself.

Winnicott then returns to the idea of blame, wisely pointing out its close connection to the concept of guilt, an experience that comes naturally with the role of parent.

"Here I must go back to the
idea of blame. It is necessary for us to be able to look at human growth and
development, with all its complexities that are internal or personal to the
child, and we must be able to say: here the ordinary devoted mother factor
failed, without blaming anyone. For my part I have no interest in apportioning
blame. Mothers and fathers blame themselves, but that is another matter, and
indeed they blame themselves for almost anything."

He sticks with his conviction that we cannot shy away from calling attention to the importance of the mother-child relationship for fear of being accused of blaming parents.

"But I have one special
reason why I feel we must be able to apportion etiological significance (not
blame), and that is that in no other way can we recognize the positive value of
the ordinary devoted mother factor- the vital necessity for every baby that
someone should facilitate the earliest stages of the process of psychological
growth, or psychosomatic growth, or shall I say the growth of the most immature
and absolutely dependent human personality."

Contemporary research at the intersection of developmental psychology, neuroscience and genetics is revealing more every day of how early experience gets into the body and brain, and how disruptions in early relationships can lead to long-term problems of both physical and emotional health. Winnicott anticipates this knowledge when he writes:

"Psycho-somatic existence is
an achievement, and although its basis is an inherited growth tendency, it
cannot become a fact without the active participation of a human being who is
holding and handling the baby. A breakdown in this area has to do with all the
difficulties affecting bodily health which actually stem from uncertainty in
personality structure. You will see the breakdown of these very early growth
processes takes us immediately to the kind of symptomatology which we find in
mental hospitals belongs initially to infant care."

He concludes with the following observation, which can serve as a kind of call to action for our society to nurture and protect these earliest relationships.

"It will be observed that
though at first we were talking about very simple things, we were also talking
about matters that have vital importance, matters that concern the laying down
of the foundations of mental health. A great deal of course is done at later stages,
but it is when the beginning is good that all that is done at later stages can
take effect."

the baby connects

About Me

I am a pediatrician and writer with a long-standing interest in addressing children’s mental health needs in a preventive model. I have practiced general and behavioral pediatrics for over 20 years, and currently specialize in early childhood mental health. I am the author of The Developmental Science of Early Childhood:Clinical Applications of Infant Mental Health Concepts from Infancy Through Adolescence" ( 2017)"The Silenced Child:From Labels, Medications, and Quick Fix Solutions to Listening, Growth, and Lifelong Resilience" ( 2016) "Keeping Your Child in Mind: Overcoming Tantrums, Defiance, and other Everyday Problems by Seeing the World Through Your Child's Eyes"(2011) " I am on the faculty of UMass Boston Infant-Parent Mental Health Program, William James College, the Brazelton Institute, and the Austen Riggs Center.